Provider Demographics
NPI:1548204126
Name:FREY, JEFFREY T (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:T
Last Name:FREY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 OLD CARRIAGE TRL
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2561
Mailing Address - Country:US
Mailing Address - Phone:814-591-1029
Mailing Address - Fax:
Practice Address - Street 1:790 VETERANS PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3915
Practice Address - Country:US
Practice Address - Phone:912-368-3868
Practice Address - Fax:912-368-3866
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002318L363AM0700X
GAGA5085363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical